Healthcare Provider Details

I. General information

NPI: 1770070526
Provider Name (Legal Business Name): LAURA SALONIA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 CROMWELL AVE
STATEN ISLAND NY
10304-3912
US

IV. Provider business mailing address

78 CROMWELL AVE
STATEN ISLAND NY
10304-3912
US

V. Phone/Fax

Practice location:
  • Phone: 718-987-9175
  • Fax:
Mailing address:
  • Phone: 718-987-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number314685
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: